Dental
Glossary

The following explanations will help you understand how the dental plans work.

Annual Benefit Maximum. For each school year (September 1 through August 31), each plan pays a maximum dollar amount toward your covered dental expenses (with the exception of the DMO® under Plan B which has no maximum). Once your dental benefits reach this dollar maximum, you are not eligible for dental benefits until the beginning of the next school year.

Copayment. After the plan pays a percentage of the reasonable and customary fee for dental services, the remaining cost is your copayment. For example, if the plan pays 80% of a basic or major service, the remaining 20% is your copayment. Keep in mind, the actual charges may be greater than what the insurance company defines as a reasonable and customary charge. If so, you are responsible for payment of any amounts over the reasonable and customary limits.

Deductible. This is the amount that you and your family must pay for covered basic and major services before the plan will pay any benefits under Plan C. You may also pay a deductible for services performed by a non-participating dentist if you are enrolled in the DMO® under Plan B.

Dentist. For the purposes of these plans, a dentist must be licensed and acting within the scope of his/her profession. Any other doctor or professional providing dental services must also operate within the scope of services he/she is licensed to perform.

Participating Dentist. A dentist who is a member of the PPO network under Plan A or DMO® network under Plan B. Keep in mind, you receive a higher level of benefits by coordinating your care through a dentist who is in the network. To obtain a directory of participating dentists, call Aetna at 1-877-238-6200.

Reasonable and Customary (R&C). The plans only pay benefits for charges that are within reasonable and customary limits. This is an amount generally charged for similar services within your geographic area. If the fee is higher than the reasonable and customary charge, you are responsible for the remaining percentage of the charge (your copayment), as well as the charges above the reasonable and customary limit.

Disclaimer: Brandywine Benefits Online provides only an overview of your benefits from Brandywine School District and The State of Delaware. Brandywine School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.

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